EA Health Research Journal

Global Health on the Brink: The United States Withdrawal from WHO, Paris Climate Accord, and the 90-Day Freeze on Foreign Assistance: Implications and Strategies for Action

2025-03-04T16:59:58+00:00

The recent executive orders by President Donald Trump to withdraw the United States (U.S.) from the World Health Organization (WHO) and the Paris Climate Agreement, compounded by a 90-day freeze on U.S. Foreign Assistance, present significant challenges to global health efforts. These actions threaten to exacerbate existing health crises, undermine decades of global health and health security gains, and leave Africa and the world more vulnerable to infectious diseases and public health threats. These decisions will likely hinder future health initiatives and disrupt critical climate change mitigation efforts. This short communication examines the potential consequences of these shifts and proposes strategies to mitigate their risks.

Urinary Bladder Invasive Squamous Cell Carcinoma in Juveniles

2025-03-04T16:55:56+00:00

Background: Invasive squamous cell carcinoma of the urinary bladder caused by schistosomal infection is associated with aggressive complications and a poor prognosis. In schistosomiasis-endemic areas, it primarily affects adults over the age of 40 and rarely occurs in children under 15. For the first time at our hospital, we report a case of urinary bladder carcinoma associated with Schistosoma haematobium eggs in a 13-year-old child from northwestern Tanzania, a region endemic for Schistosoma haematobium.

Case Presentation: A 13-year-old girl presented with left loin pain, turbid yellow urine, and upper limb pain for over a month. Multiple evaluations, including laboratory and ultrasonographic investigations, were conducted. Ultrasound findings revealed severe enlargement of both kidneys, with the left kidney being larger than the right. A computerized tomography (CT) scan showed severe bilateral hydronephrosis and hydroureter, likely due to vesicoureteral junction obstruction. A left nephrectomy was performed; however, the patient continued to experience dysuria. During cystoscopy, a tumor was identified on the left posterolateral wall of the bladder. Surgical exploration revealed adhesion of the tumor to the uterus, bladder neck, and cervix. A cystectomy was recommended, during which part of the right ureter was removed, and the remaining portion was anastomosed to the sigmoid colon. Histopathological examination of the tissue samples revealed invasive squamous cell carcinoma (Grade 1) involving the cervix and vaginal wall. Additionally, multiple active and calcified Schistosoma haematobium eggs were observed. The patient was referred to the oncology unit for radio-chemotherapy, where she continues to receive treatment.

Conclusion: Chronic inflammatory responses associated with Schistosoma haematobium eggs in the urinary bladder walls can lead to severe complications affecting the entire urogenital system, regardless of age. These inflammatory responses may contribute to the development of squamous cell carcinoma even in young individuals.

Psychological and Occupational Factors Associated with Depression Among Healthcare Providers During the COVID – 19 Pandemic in A Regional Referral Hospital in Kisumu County

2025-03-04T16:55:56+00:00

Background: Corona Virus Disease of 2019 (COVID-19) spread across the globe, causing distress among various
populations, including healthcare providers. This disease has had an unparalleled effect on the world’s economic
situation, livelihood, mental and physical well-being across the globe.
The study aimed to determine the prevalence of depression and identify the occupational and psychological factors
associated with depression among health care providers during the COVID-19 pandemic in a regional referral hospital
in Kisumu County.
Methods: We conducted a hospital-based cross-sectional study at JOOTRH where a total of 202 respondents participated
in the study. The survey questionnaire consisted of four components: demographic factors, occupational factors, and
psychological factors. Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9). Data was
analysed using the statistical package for Social Science version 28. Pearson chi-square was used to determine the
occupational and psychological factors associated with depression during the COVID-19 pandemic at p ≤ .05.
Results: The overall prevalence of depression was at 57.4%. The occupational and psychological factors associated with
depression among healthcare providers during the COVID-19 pandemic included being over 30 years old, married,
having over 6 years of work experience, COVID-19 training, having an irregular work schedule, lacking psychological
support services, and facing stigma.
Conclusion: The study findings revealed a considerable proportion of depressive symptoms among health providers
during the COVID-19 pandemic at JOOTRH. Older age, being married, more years of work experience, previous
exposure to pandemic, having COVID-19 training, and irregular work schedule, experience of stigma, and lack of
psychological support were significantly associated with depression.

Antibody Responses to SARS-CoV-2 among Health Care Workers in North-Eastern Tanzania

2025-03-04T16:55:56+00:00

Background: Health Care Workers (HCWs) have been playing crucial role in treating patient with COVID-19. They
have a higher occupational risk of contracting the disease than the general population, and a greater chance of them
transmitting the disease to vulnerable patients under their care. Given the scarcity of HCWs and low COVID-19 vaccine
acceptance in Africa, it is essential that HCWs are seroprotected and their exposure to COVID-19 minimized
Objective: To determine IgG antibody response to SARS-CoV-2 among HCWs of a tertiary hospital in North Eastern,
Tanzania.
Methodology: This cross-sectional study was carried out among 273 HCWs at Kilimanjaro Christian Medical Centre
(KCMC), a tertiary, zonal referral hospital in Tanzania’s North Eastern region. Stratified sampling was used to select
study participants. Data were obtained from each consenting participant using a validated questionnaire. Blood samples
were collected for SARS-CoV-2 IgG antibody quantification using an indirect ELISA test. RedCap software was used to
manage data. Statistical analysis was done using STATA statistical software version 15 and GraphPad Prism v 9.0. A
p-value of <0.05 was considered the cut-off for statistical significance.
Results: Among 273 HCWS, 37.9 % reported receiving the COVID-19 vaccine. Except for one person, all of the
participants (99.6%) had SARS-CoV-2 IgG antibody concentrations that were positive, with 64.5% of them having strong
seropositivity. Cadre, sex, BMI, smoking status, adherence to recommended hand hygiene practices and COVID-19
patient interactions were significant predictors of variation of median SARS-CoV-2 antibody concentration. Age, usage of
personal protective equipment, history of previously testing PCR positive for COVID-19, and total number of COVID-19
patients exposed were found to cause no statistically significant variation in median antibody concentration among
participants.
Conclusion: This study identified a high seroprevalence of SARS-CoV-2 antibodies among healthcare workers in the
study setting, indicating significant exposure to SARS-CoV-2 virus, despite only a minority of them being vaccinated.
These findings underscore the need for robust communicable disease prevention strategies including; regular screening
and pathogen surveillance to better prepare for potential future pandemics. Such measures are critical to mitigating the
substantial impacts on health care workers and ensuring the resilience of the healthcare system.

Sustaining Functionality of Not-for-Profit Health Organisations During Pandemics: Lessons and COVID 19 Experience from Makerere University Walter Reed Project

2025-03-04T16:55:57+00:00

Not for profit health organisations (NPHOs) complement government health response efforts, hence the need for their continued functionality during pandemic situations. In this article we highlight lessons from Makerere University Walter Reed Project’s (MUWRP) efforts to ensure continuity of its health mandate during the corona virus disease 2019 (COVID-19) outbreak. Our findings provide cues for other developing world NPHOs as they prepare for the next outbreak. When the first case of COVID-19 was reported in Uganda, MUWRP’s leadership identified four strategic pillars of action; minimising the risk of spread of the malady, ensuring continuity of all health activities, early identification and support for casualties, and prevention. An infection prevention and control (IPC) committee was set up to lead response efforts. Innovations per pillar such as adoption of information technology to ensure virtual working and meeting, bringing vaccines to the doorsteps of interested staff, free COVID testing, alternate employee working schedules, introduction of temperature guns, and weekly IPC review meetings were implemented. Routine demographic, testing, positivity, and treatment data was exported to STATA 15.1 for analysis. By the declaration of the end of the pandemic by the WHO, the average positivity rate of COVID-19 among 196 MUWRP staff was 7%, with 95% of all cases being mild, and 94.3% cases managed through home-based care. Only three cases were referred to hospital. Overall, males 30 to 40 years were most affected. Vaccination completion was at 89%, and there were no fatalities reported. Employing the four pillars and related innovations were key to minimising the effects of COVID-19 at MUWRP and are a relevant adaptable tool for other NPHOs in the developing world, as they prepare for the next pandemic.

Remote Teaching in a Rwandan Emergency Medicine Residency: A Viable Option with Limited In-person Staff

2025-03-04T16:55:57+00:00

Low and middle-income countries (LMIC) in Africa face challenges in medical education. Eleven countries have no medical school, 24 countries share one medical school, and few have residency programs. This shortage means that Africa has only 1.7% of the world’s physicians, yet bears 27% of the global disease burden. COVID-19 created further educational constraints, especially in emergency medicine (EM). Student and resident education opportunities were limited. Rwanda faced a shortage of available in-person EM residency instructors during the pandemic, and to support learning needs, we designed and implemented a remote teaching model to substitute in-person instruction. The objective of this study was to evaluate whether remote and pre-recorded teaching is positively received by EM learners and if it is a viable supplement in resource limited settings.
Pre-recorded lectures were presented to residents, with lecturers remotely available. We evaluated the program using the first-level Kirkpatrick framework (suitability/satisfaction) via a quantitative and qualitative post-lecture survey. The survey was completed by residents in attendance. Responses were analyzed using descriptive statistics. Outcome measures included learner satisfaction, lecture quality, technological quality, and situational suitability. Qualitative and free-response data was
An average of 11 Rwandan EM residents attended 18 lectures. Using a Likert scale, the composite learner satisfaction score was 4.25 (σ = 0.1), the lecture quality score was 4.2 (σ = 0.1), the technological quality score was 4.0 (σ = 0.36), and the situational suitability score was 4.25 (σ = 0.07). These results indicated overall satisfaction with the lectures. Lower scores were given regarding lecturer accents and speech rates. Qualitative feedback did not demonstrate significant dissatisfaction with quality or suitability.
When in-person lecturers are unavailable, pre-recorded, remote instructional methods may be an appropriate substitute. Future directions may include piloting the project with a larger, multinational cohort or in LMICs with greater technological or resource limitations.

Hepatitis B Viral Infection and its Associated Factors among Population Aged at Least 15 Years in Three Selected Cities of Burundi

2025-03-04T16:55:57+00:00

Background: Hepatitis B virus infection is a common cause of viral hepatitis and affects 257 million people worldwide. Hepatitis B virus disease is a potentially life-threatening liver infection and a major global health problem that puts people at high risk of death from cirrhosis and hepatocarcinoma. The present study sought to investigate the proportion of hepatitis B virus (HBV) and associated factors for its transmission among people aged at least 15 years in three selected cities of Burundi attending the HBV screening campaign.
Methods: We conducted a cross-sectional design by selecting conveniently 629 consenting participants aged at least 15 years during the screening campaign in three selected cities of Burundi namely Gitega, Rumonge and Cankuzo in June 2022. During the campaign, a structured questionnaire was administered by trained healthcare workers to collect socio-demographic and behavioural characteristics, as well as the history of exposure to HBV. HBV screening tests were performed with Cypress Diagnostics HBsAg Cards (Hulshout, Belgium). Univariate and multivariable logistic regression analyses were used to assess factors associated with HBV infection in the screened participants.
Results: The study included 629 participants, 8.43% of whom tested positive for hepatitis B viral infection, with a mean age of 37.84 (SD=13.9) years. The participants were predominantly found in the over 50 years age group (31.1%) and the 18-30 years age group at 26.69%, the married (70.6%), the female (57.71%), and the farmers (60.25%), Rumonge city dwellers (33.39%), and those with a primary school level (36.25%). In this study, the associated factors with viral hepatitis B infection were residence in Cankuzo (OR=2, CI= 1-4, p=.04), and history of sharing sharp materials (OR=1.8, CI=1-3.3, P=.03).
Conclusion: HBV infection was significantly associated with residence in Cankuzo and sharing sharp materials. HBV infection is endemic in these three provincial cities namely Cankuzo, Gitega and Rumonge. Given the various ways for HBV infection to occur within a general population, control of hepatitis B and its associated factors is one of the highest priorities in order to mitigate its transmission and monitor continuous exposure among Burundian population. There needs to be more help in the form of screening, immunizations for adults and other preventative measures, as well as treatment for the patients.

Cases of Guinea Worm Disease Among Al Sabah Children Hospital Attendees from January to December 2022, South Sudan

2025-03-04T16:55:57+00:00

Background: Guinea worm disease carries health risks with potential effects on social and economic wellbeing of an individual and community. Emergence, the fact of manually removing the worm , is slow, painful , and disabling and therefore, it has a serious adverse socioeconomic outcome on the health, agricultural productivity, and school attendance of affected population. This study was conducted to identify case of Guinea worm among children attending Al Sabah Children Hospital, South Sudan.
Methodology: The study extracted register data which covered the period from January to December 2022. Using a systematic random sampling, 422 children were selected from the hospital’s Statistics Department of Al Sabah Hospital. Descriptive data analysis was performed using SPSS Statistics software.
Results: Of the children who received hospital services, the vast majority (76.3%) were children <5 years old, and more than half were females. None of the sampled children had Guinea worm infection.
Conclusion: In 2022, none of the attendees of the Al Sabah Children Hospital was diagnosed with Guinea worm infection. But this does not mean that the country is free of the disease as the study design did not allow to establish true prevalence.

Faecal Carriage of Multidrug Resistant Enterobacterales and Associated Factors among Neonates Admitted at Tertiary Hospital in Dar es Salaam, Tanzania

2025-03-04T16:55:57+00:00

Background: Hospitalised neonates are at increased risk of carrying extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales (CPE), possibly leading to invasive infections. This study determined the faecal carriage of ESBL-PE, CPE, and associated factors among neonates at Muhimbili National Hospital (MNH).
Methods: A hospital-based cross-sectional study was conducted among neonates aged ≤ 28 days admitted at MNH. The participants’ data and rectal swab samples were collected. Samples were processed to detect ESBL-PE and CPE. Results were confirmed using the double-disc diffusion synergy test and modified carbapenem inactivation method, respectively. An antimicrobial susceptibility test was performed using the Kirby Bauer disk diffusion method.
Results: Three hundred forty neonates with a median age of 3 days (IQR: 2-9) were enrolled. The carriage rate of ESBL-E and CPE was 39.4%(134/340) and 1.8%(6/340), respectively. Klebsiella pneumoniae (66.9%) and Escherichia coli (66.7%) were the common isolates for ESBL-PE and CPE, respectively. The factors independently associated with ESBL-PE carriage were antibiotic use (aOR 2.73, 95% CI: 1.38-5.39, p=.04), age increase (aOR 1.09, 95% CI: 1.02-1.15, p=.006), prolonged hospitalisation (aOR 2.92, 95% CI: 1.17-7.29, p=.02), and neonate-sucking their fingers (aOR 2.98, 95% CI: 1.04-8.58, p=.04). The study observed a trend of CPE carriage toward neonates with prolonged hospitalisation (p=.05). ESBL-PE low resistance was observed to meropenem (0.9%), amikacin (2.7%-6.7%), and gentamicin (19.4% to 100 %).
Conclusions: The study revealed a relatively high carriage rate of multidrug resistant Enterobacterales among neonates admitted to a tertiary hospital. These findings underscore the importance of continuous surveillance of ESBL-PE and CPE to prevent infections and limit their potential transmission within hospital settings and the community.

Using Theory of Planned Behaviour to Assess the Determinants of Uptake of Modern Family Planning among Women of Reproductive Age in Rural Settings of Morogoro, Tanzania; A Cross-Sectional Study

2025-03-04T16:55:57+00:00

Background: Modern family planning is considered one of the most cost-effective health intervention to improve the well-being of women and newborns. Little is known about the influence of the theory of planned behaviour on the uptake of modern family planning. Therefore, the study aims to address the existing gap in using the theory of planned behaviour to explain the uptake of modern family planning in rural settings of Morogoro, Tanzania.
Methods: The community-based analytical cross-sectional study was conducted at Malinyi District in rural Morogoro, in June to July 2022. A multistage sampling technique was used to select 421 women of reproductive age. A structured questionnaire adapted from previous studies was used as the data collection tool. The determinants for the uptake of modern family planning were analyzed using bivariable and multivariable binary logistic regression model. The final results, which were statistically significant from the regression analysis model were presented using Adjusted Odd’s Ratio (AOR), Confidence Interval (95% CI), and p-value < .05.
Results: The majority of women of reproductive age, 328 (78%), were using modern family planning methods, with more than half of respondents (54.1%) using implants. Depo Provera (29.1%) and the pill (14.4%) were the second and third most frequently used methods. Only 4.9% reported IUCD and 2.8% condom use. The majority of the women, 342 (81%), had a positive attitude, positive subjective norms 289 (68.6%), positive perceived behaviour control 388 (92%), and high intention on uptake of modern family planning 61 (85.7%). The women with a positive attitude on modern family planning uptake (AOR 2.307: 95% CI, 1.243 to 4.281) and positive perceived Behavioural control (AOR 6.015: 95% CI; 0.017 to 2.569) were more likely to be significantly associated with increased uptake of modern family planning. Those with high intention on uptake of modern family planning (AOR 0.038; 95% CI; 0.018 to 0.080) were less likely to be significantly associated with increased uptake of modern family planning.
Conclusion: Positive attitude and high perceived behavioural control have a direct positive effect on the uptake of modern family planning. The family planning education-based programs could be offered to the community, particularly in rural areas, to maximise the community awareness and uptake of modern family planning. The theory of planned behaviour could predict intention to use but not the actual utilisation of modern family planning. A combination of theoretical models may be required to understand additional external elements that may influence the utilisation of modern family planning.

A Qualitative Exploration of Perceptions and Experiences of Adolescent Girls and Young Women on Modern Contraceptive Methods Use in Malinyi District, Morogoro, Tanzania

2025-03-04T16:55:57+00:00

Background: Despite the existence of plans and strategies for providing family planning methods in Tanzania, the uptake rate of modern contraceptives among Adolescent Girls and Young Women (AGYW) in Tanzania remains low. The fertility rate is 112 per 1000; only 15.2% of adolescents are using Modern Contraceptives Methods (MCMs) in Tanzania. Modern contraceptive use is one of the important interventions to reduce the burden of adolescent pregnancy which is as high as 22% in the country. However, little is known regarding AGYW’s perceptions and experiences with MCMs.
Objective: To explore the perceptions and experiences of AGYW with MCMs use in the Malinyi district of Morogoro, Tanzania.
Materials and Methods: This was a qualitative phenomenology study. Purposive sampling was used to select 19 study participants. An in-depth interview guide was used to collect data. Data were transcribed verbatim. A thematic data analysis approach was used to analyze data.
Results: Two major themes that emerged from the findings were experiences and perceptions of AGYW on MCM use. On the experiences of MCMs, the study findings revealed that AGYW have limited knowledge and awareness about modern contraceptive methods; some of them acknowledged the benefits of modern contraceptive methods in preventing unintended pregnancies, providing a sense of empowerment, and enabling them to pursue their life goals. On perceptions of MCM use some of the study participants shared challenges encountered, including side effects, social influence, cultural and religious beliefs, myths and misconceptions that contribute to the perceptions and use of MCMs.
Conclusion and recommendation: Healthcare providers at the health facilities should continue educating AGYW on the importance of using MCMs.

Acute Kidney Injury: Magnitude and Predictors of Maternal Outcomes among Pre-Eclamptic and Eclamptic Women in Mwanza, Tanzania

2025-03-04T16:55:57+00:00

Background: Acute kidney injury (AKI) that occurs during pregnancy or in the post-partum period is a serious obstetric complication with a significant risk of feto-maternal morbidity and mortality. Although globally there has been an overall decrease in the burden of pregnancy-related (PRAKI) AKI, recent studies show the increasing occurrence of this disease in Low-middle income countries (LMICs).
This study was conducted to determine the magnitude and predictors of maternal outcomes of pre-eclamptic and eclamptic-related acute kidney injury at Bugando Medical Centre (BMC) and Sengerema Designated District Hospital (SDDH) Mwanza, Tanzania.
Methods: A cohort study was conducted involving patients diagnosed with Preeclampsia-Eclampsia (PE-E) who were admitted at BMC and SDDH from November 2021 to June 2022. Data were collected through convenience sampling using a structured questionnaire. Statistical data analysis was performed using STATA version 15. A chi-square test was performed to test for significant associations between the predictor and outcome variables. A significant association was defined as a p-value of less than .05. Variables showing significant associations in the chi-square analysis were further analysed using multivariate logistic regression to evaluate the strength of the associations.
Results: The study enrolled a total of 258 women with PE-E. The magnitude of AKI was found to be 141(54.7%,) out of 258 participants, of which Kidney Disease Improving Outcomes (KDIGO) stage 1 accounted for 103 (73%) stage 2, 20 (14.2%) and stage 3, were 18 (12.8%). Of these, 141 participants with AKI, 101 (71.6%) resolved within 7 days of delivery, 12 (8.5%) persisted beyond 7 days after delivery, and 28 (19.8%) worsened. Serum creatinine stages 2 and 3 at admission, HIV positive status, and informal education status were highly associated with persistent/worsening AKI stage.
Conclusion: The magnitude of acute kidney injury was found to be high (54.7%) among pre-eclamptic and eclamptic patients in BMC and SDDH. AKI stages 2 and 3, HIV positive status and informal education level were associated with poor maternal outcomes mainly persistent AKI and worsening AKI.

Multisectoral and Inclusive Strategies for Improving Pregnant Adolescents’ and Teenage Mothers’ Access and Utilization of Sexual and Reproductive Health Services in Kenya

2025-03-04T16:55:57+00:00

Background: Adolescent girls between 15 and 19 years of age make up just over one-fifth of the women of Kenya, and they account for 14% of all births. This study explored barriers to access and utilization of sexual and reproductive health services (SRH) for pregnant adolescents and teenage mothers in Kakamega County (Kenya).

Methods: The qualitative study included a desk review, interviews and focus group discussions and a validation workshop with the engaged stakeholders to produce a framework for action.

Results: The main barriers emerged in the following domains: acceptability (stigma and socio-cultural influences, negative healthcare workers attitude, lack of privacy and confidentiality), accessibility (distance to the health facility, costs for transport and drugs, opening times), availability (lack of staff, drugs and equipment, low coverage of SRH services specific for adolescents), contact/use (lack of information about SRH services offered), effectiveness (poor collaboration between all the relevant sectors and stakeholders, lack of adequate financing, no inclusion of adolescent perspectives in the policy-making process, lack of reliable data). Moreover, COVID-19 starkly impacted access and utilization of the services.

Conclusion: A pathway to impact framework was coproduced building on the findings of the research to guide decisionmakers in Kakamega and Kenya to improve access and utilization of SRH services for adolescents and especially pregnant girls and teenage mothers. Crucially, a multisector and multistakeholder approach including adolescent voices, could support the effectiveness of SRH services for adolescent girls.

Dolutegravir Associated glycaemia Among Persons with HIV on Treatment at a Kenyan Referral Hospital

2025-03-04T16:55:57+00:00

Background: Dolutegravir-based antiretroviral therapy is a clinically proven treatment option for persons living with the human immunodeficiency virus. However, there is emerging clinical evidence that its use may result in hyperglycaemia, but there is limited data in Africa.
Objectives: To determine the prevalence of dolutegravir-associated hyperglycaemia and its covariates among Persons Living with HIV on treatment in a tertiary teaching and referral hospital in Kenya
Methods: A cross-sectional study was undertaken among adult patients who had been using dolutegravir-based regimens for at least 3 months at the comprehensive care centre in Kenyatta National Hospital. An interviewer-administered questionnaire was used to collect sociodemographic characteristics while clinical data (viral load, CD4 count) were abstracted from patients’ charts. Blood samples were taken to determine random blood sugar and glycated haemoglobin levels. Data were analysed using STATA® statistical software. Associations between hyperglycaemia and patients’ sociodemographic and/or clinical data were determined as appropriate whereas the independent correlates of hyperglycaemia were determined through multivariable logistic regression at P≤.05.
Results: We recruited 358 participants all on dolutegravir based therapy and predominantly female (62.0%). Median age was 444 (IQR 38 to 50) years. Prevalence of hyperglycaemia was 55.9%. Age above 40 years (aOR1.7; 95% CI, 1.1 to 2.7; P=.026), being overweight (aOR 1.7; 95% CI, 1.1 to 2.8; P=.026) and obesity (aOR 3.1; 95% CI, 1.7 to 5.5; P<.001) were associated with experiencing hyperglycaemia.
Conclusion: Dolutegravir-based regimens are associated with hyperglycaemia among patients with advanced age and elevated body mass indices.

Evaluation of Clinical and Histopathological Diagnosis of Kaposi’s Sarcoma at Muhimbili National Hospital, Dar es Salaam, Tanzania

2025-03-04T16:55:57+00:00

Background: Treatment and outcome of Kaposi’s sarcoma (KS) depend on a correct histopathological diagnosis, however, most KS cases in developing countries are diagnosed clinically without histopathological confirmation, which results in either over or under-diagnosis. Also, due to the number of histopathological mimickers in different stages of KS which include benign to fatal conditions, the histopathological diagnosis of KS is not always correct. However, the HHV-8-LANA-1 Immunohistochemical (IHC) stain is positive in nearly all KS lesions and is considered to be an important diagnostic tool to differentiate KS from its histological mimickers. This study aimed to determine the quality of Kaposi’s sarcoma diagnosis at MNH and whether it can be improved by the routine of HHV-8-LANA-1 immunohistochemical stain.
Methodology: This was a retrospective cross-sectional hospital-based study of all KS cases diagnosed either by clinical, histopathological, or both in 2018. KS was diagnosed based on H&E morphology and confirmed by HHV-8-LANA-1 immunohistochemistry. The diagnosis utility of clinical and histopathology was compared with HHV-8-LANA-1 immunohistochemistry.
Results: There was almost perfect agreement between initial and reviewed histopathology for KS diagnosis (Kappa value= 0.892, p-value=.000). The clinical diagnosis concordance rate was 61% with no agreement (Kappa value -0.123, p-value=0.102). Clinical differential diagnosis included a wide range of pathological conditions ranging from less severe inflammatory to fatal malignant conditions. There was a substantial agreement between initial histopathology and HHV-8-LANA-1 IHC for KS diagnosis (Kappa=0.70, p-value .000) with a histopathology concordance rate of 88%.
Conclusion: Histopathological examination of all clinical KS suspicions and HHV-8-LANA-1 immunohistochemistry confirmation is required since the study showed that the histopathology misdiagnosis of KS at MNH was unlikely to be the result of human error. We recommend that in every clinically suspected KS case, an adequate tissue biopsy should be taken for histopathology analysis and HHV8-LANA-1 immunostaining to avoid inappropriate treatment.

Self-Medication Practice and Associated Factors Among Health Science Students in Central Tanzania

2025-03-04T16:55:57+00:00

Background: Self-medication practice is highly prevalent worldwide despite the scaled-up campaigns to refrain from using drugs without a prescription. Inadequate knowledge has been associated with the increasing practice of self-medication among students. The study aimed to determine the prevalence of self-medication and explore factors associated factors with the practice among health science students.
Methods: A cross-sectional study was conducted in Dodoma, where 255 students were interviewed using a self-administered adapted questionnaire. Univariate and multivariate analysis were performed using SPSS version 25.
Results: Self-medication prevalence was 69%. Paracetamol (52.1%) and Ibuprofen (29.4%) were primarily used for relief of headache (76.7%) and menstrual pain (18.2%). Among the studied students, 59.6% had inadequate knowledge, while 60.8% had a positive attitude towards self-medication. Mode of hospital payment (cash) (AOR=3.75; 95% CI: 1.868-6.825 p<.001) and household income (<10,000TSh) (AOR=2.868; 95% CI: 1.355-6.071 p=.006) were significantly associated with self-medication practice.
Conclusion: Self-medication practice among health science students is prevalent. Inadequate knowledge and low socioeconomic status play a significant role in self-medication practice. Increasing students’ access to inexpensive healthcare options and counselling services may help in reducing self-medication practices.

Predictors of Smartphone Usage Addiction among Health Sciences Students in Selected Universities in Kampala, Uganda

2025-03-04T16:55:58+00:00

Background: Globally, smartphone use among university students is expanding at an exponential rate, and its lingering addiction has now become a global issue, causing some emotional comprehension issues that can lead to significant consequences. Hence, this study aimed to assess the magnitude of smartphone addiction (overuse) and its predictors among health sciences students at selected universities in Kampala, Uganda.
Methodology: An online-based descriptive cross-sectional study design was employed for this study among 308 students of health sciences in Ugandan universities. A three-sectioned, pretested, and validated questionnaire was used to capture data on socio-demographic attributes and smartphone use habits from the respondents. The data were analysed using IBM SPSS version 26. The outcome variable (i.e., smartphone addiction) was transformed into a weighted aggregate score prior to dichotomisation. Analysis of variance, chi-square test of independence, and binary logistic regression analysis were employed for the study hypotheses, and the significance level was set at P ≤ .05.
Results: The prevalence of smartphone addiction was found to be 53.9%. Female respondents were predominant, 179 (58.1%), and relatively three-quarters of the respondents, 237 (76.9%), were unmarried. The smartphone addiction score among the respondents was 16.13 (95% confidence interval [CI], 15.49 to 16.78) on a maximum reference scale of 30. At the multivariable model, daily time spent using a smartphone (AOR 0.40; 95% CI, 0.23 to 0.69) and the onset of smartphone use (AOR 0.55, 95% CI, 0.31 to 0.97) were identified as the significant independent predictors of smartphone addiction.
Conclusion: This study reported a high prevalence of smartphone addiction among the sampled health sciences students in Ugandan universities. The most significant predictors of smartphone addiction include the number of hours spent on a smartphone daily and the onset of smartphone use. Given the negative health outcomes that this problem may evoke, this study calls for targeted health education intervention to enhance self-control skills, and to effectively tackle smartphone addiction among university students in Uganda.

Psychosocial Challenges and Coping Strategies Among Adults Living with HIV in Ubungo Municipality, Tanzania: A Qualitative Descriptive Study

2025-03-04T16:55:58+00:00

Background: People living with HIV (PLWH) face numerous psychosocial challenges within the context of healthcare systems and the community where they live. This study aimed to describe psychosocial challenges and individual coping strategies among adults attending Care and Treatment Clinics (CTCs) in Ubungo Municipality, Tanzania.
Materials and Methods: A qualitative descriptive study was conducted at CTCs in Ubungo Municipality, an urban setting in Dar es Salaam. Data were collected through audio-recorded in-depth interviews with 10 purposively selected participants. Audio files were transcribed verbatim and analyzed using a thematic analysis approach.
Results: Difficulty in accepting HIV-positive test results, feeling desperate, fears of HIV disclosure, HIV-related stigma, and financial instability related to HIV infection were the main psychosocial challenges described by the participants. However, their main coping strategies included seeking social support, positive experiences from regular CTC attendance, adaptive coping, disregarding people’s comments, and seeking HIV-related information.
Conclusion: PLWH encounter various psychosocial challenges. Feeling desperate, fear of HIV disclosure, and HIV-related stigma are the main causes of psychosocial distress among people diagnosed with HIV. Changing the individual perspectives on these challenges through effective coping strategies can improve the quality of life for PLWH. The Ministry of Health, through the National AIDS Control Program, can design interventions focused on addressing these challenges. Future research should be undertaken to quantify the magnitude of these challenges and the coping strategies in similar settings.

Prevalence, Pattern and Treatment of Traumatic Bone Loss Following Long Bone Open Fractures at Kilimanjaro Christian Medical Centre

2025-03-04T16:55:58+00:00

Background: Bone loss resulting from open long bone fractures is a significant concern in low-income countries. This study aims to assess the prevalence, pattern, and treatment of traumatic bone loss in northeastern Tanzania.
Methods: A hospital-based cross-sectional analytical study was conducted at the Orthopedics and Trauma Department of Kilimanjaro Christian Medical Centre (KCMC) from August 2020 to February 2023. The sample size comprised 365 participants with 394 open injuries. Data collection involved a structured electronic questionnaire, and statistical analysis was performed using SPSS version 25.
Results: The study found that 14.7% of the patients treated at KCMC had traumatic bone loss following open long bone fractures. The majority of these patients were young males from rural areas involved in road traffic crashes. Comminuted fractures, especially in the tibia and fibula, were the most common fracture patterns associated with bone loss. Surgical debridement and external fixators were the primary treatment approach for patients with bone loss.
Conclusion: Traumatic bone loss following open long bone fractures is a significant issue in northeastern Tanzania. This study highlights the association between injury pattern, as per Gustilo classification, and the severity of the injury, consequently influencing the treatment plan and the potential for limb salvage. The factors significantly associated with bone loss were the Gustillo IIIB/IIIC classification of open fractures, fractures in the tibia and fibula, fibula fractures, and residence in an urban area.

Determinants of Practice and Adherence to Infection Prevention and Control of Neonatal Sepsis Among Nurses in Selected Health Facilities of Pwani Region, Tanzania

2025-03-04T16:55:58+00:00

Background: Although guidelines on neonatal care and infection prevention exist, it is unclear what factors influence nurses’ adherence to infection prevention and control (IPC) in neonatal care. This study aimed to assess the determinants of nurses’ adherence to IPC in neonatal sepsis prevention in the Pwani Region, Tanzania.
Methods: A cross-sectional study with 282 nurses was conducted. Assessing the how Socio demographic characteristics, Health facility factors, attitude of the nurses affect the Nurse’s practices on adherence to IPC for prevention of neonatal sepsis. Data collection methods included a questionnaire and an observation checklist. Bivariate and multivariate logistic regression were employed to determine the factors influencing nurses’ adherence to IPC. Nurse’s adherence to IPC was measured using the mean score whereby those who score above the mean were regarded as adequate adherence. A Probability value of .05 and a 95% confidence interval was regarded as statistically significant.
Results: The present study found that only one-third (37.0%) of the nurses had adequately adhered to IPC. Significant associations were observed between nurse’s adherence to IPC in the prevention of neonatal sepsis and; working experience of 13 to 24, 7 to 12, and 6 months [AOR =5.30, p<.001], [AOR=3.9, p<.024] and [AOR=3.640, p<.001] respectively, >10 years in nursing professional [AOR=2.627, p<.023], staffing of 6-10 and 1-5 [AOR=5.992, p<.001] and [AOR=3.791, p<.001] respectively, 3 and >3 staffs per shift [AOR=3.276, p<.017] and [AOR=2.364, p<.017) respectively, working at District and regional hospitals [AOR=1.101, p<.001] and [AOR= 2.320, p<.028] respectively, on-job training [AOR = 2.08, p<.034], isolation room availability [AOR=1.783, p<.042], SOPs and IPC guidelines availability [AOR=4.320, p<.004], sufficient medical equipment and supply [AOR =1.414, p<.015] and positive attitude [AOR=1.490, p<.035].
Conclusion: The study results indicated Nurse’s adherence to IPC in the prevention of neonatal sepsis is associated with working experience, staffing, healthcare level, on-job training, isolation room availability, current SOPs and IPC guidelines, access to medical equipment/supply, and positive attitude. Strategies should be employed to strengthen the adherence of nurses to IPC guidelines to minimize the morbidity and mortality resulting from neonatal sepsis. Interventional studies from each factor for nurse’s adherence to IPC in the prevention of neonatal sepsis should be of priority.

‘No One Has Taught Us to Have It All’: Reflections from Women on the Gender-Based Challenges in Surgical Careers in Africa

2025-03-04T16:55:58+00:00

Background: The surgical field in Africa has long grappled with a gender imbalance, with women being significantly underrepresented. Despite global efforts to foster gender diversity in healthcare practices, African women pursuing surgical careers still face substantial hurdles. This paper investigates these women’s experiences and challenges, aiming to raise awareness of these issues and propose strategies for improving gender equity.
Objective: To describe contextual aspects of barriers affecting women in surgery in Africa.
Methods: A cross-sectional survey was conducted, targeting female medical students interested in surgical careers, interns, trainees, and surgical consultants across Africa. The survey was distributed in November-December 2021. Data were analysed using descriptive statistics for quantitative data and a simplified thematic analysis for qualitative data.
Results: A total of 105 participants from 17 countries, aged 20 to 50 years and with various training levels, completed the survey. General surgery was the most common speciality among the respondents. Notably, 63% reported gender-based discrimination, with many (74%) attributing societal and familial discouragement and financial commitments as major barriers to pursuing surgical careers. Participants also shared experiences of gender-based inequity, underestimation of their skills, sexist comments, and even instances of sexual harassment during training or work.
Conclusion: This study sheds light on the complex barriers African women face in pursuit of surgical careers. To enhance diversity in the field, fundamental change is required. This necessitates recognising the underlying causes hindering women’s progress in surgery and the implementation of interventions to promote gender equity.